Getting Oats onto the menu for people with Coeliac Disease

This presentation was by Jason Tye-Din MBBS, PhD, FRACP 

Head Coeliac Disease Research Lab, Walter Institute and Eliza Hall Institute, Gastroenterologist, the Royal Melbourne Hospital. Principle Research Fellow, The University of Melbourne.
Medical Advisory Committee, Coeliac Australia. 

  • Oats are highly nutritious by uncertainties around oat safety remain
  • Some people with coeliac disease report problems tolerating oats
  • In Australia and NZ, oats are excluded from the gluten-free diet
  • Elsewhere UK, US, Europe & Nth America, oats are generally allowed and can be labelled 'gluten free'

Many Potential Benefits of Oats 

  1. Oats is a highly nutritious cereal - Quality protein, good source of resistant starch and soluble fibre. Rich in B group vitamins, iron, zinc, magnesium, phosphorus, polyunsaturated fatty acids and phytochemicals. 
  2. Improves cardiovascular disease risk markets, total cholesterol & LDL & BMI, bodyweight, and waist circumference
  3. Benefit to diabetes sufferers, reduces postprandial blood glucose and insulin response, improving fasting glucose
  4. Positive gastrointestinal effects with excellent fibre, increasing satiety, adds palatability and diversity to the diet, prebiotic effect with increased beneficial microbiome.

Comparison between Oats, Rice & Corn nutritional value

Oats nutritional value 

The effects of gluten free cereals based on corn, soy and sugar compared to Uncontaminaed oats. 

 

 Oats is effectively the same family as Wheat, Rye & Barley but a different tribe: 

100g Wheat contains - 11g gluten

100g Barley contains - 4g hordein

100g Rye contains - 8g secalin

100g Oats contains - 1g avenin

Important insights from oat immune studies

 

Small intestine T cells from people with coeliac disease can be stimulated by avenin peptides (2004)

Circulating T cells can be identified in the blood 8% of coeliac patients after they consume oats (2015)

Avenin can definately activate an immune response in some coeliac patients, most people did not have small intestinal damage with 6 week response.

  • Supportive of contamination free oats in the gluten free diet for tolerant people
  • Clinical follow-up recommended to detect the small few who have issues
  • Enabling informed choice in food labelling important so those who wish to avoid can do so

    Where to from here in Australia?
  • Patients with coeliac disease could benefit from pure oats with health conditions such as Type 1 diabetes, constipation, metabolic issues, palatability. Discuss with health professionals and monitor symptoms and small histology. 
  • Introduce gradually, monitor symptoms - if they persist discontinue
  • Suggest to start with 25 - 50g serve daily for 5 days out of the week
  • Baseline scope, 3 month pure oat challenge, repeat scope

Kylie: I was surprised at the amount of studies that were referred to, some as early as 2004, papers which I was aware of as these studies were completed in the lead up to pure oats being introduced into the US in 2005 as certified gluten free oats. Many studies I have been quoting for 10 years and have been highly criticised for doing so. It is a shame that after so many years patients have been given false information about the value of oats in a gluten free diet, and I'm disappointed this did not give a decisive action for coeliac patients to give them confidence to introduce oats into their diet. 

 

This is the protocol for introducing oats to the diet

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